Composition for treating xerostomia or dry mouth

ABSTRACT

The present invention provides a composition comprising olive oil, trimethylglycine and xylitol for treating xerostomia and disorders associated thereto, with very good results in increasing the unstimulated salivary flow, in alleviating the symptoms of xerostomia, including the pain associated to xerostomia, as well as improving the quality of life of affected persons. The composition of the invention has also been proved to protect dentin against demineralization in acid conditions.

FIELD OF THE INVENTION

The invention refers to the field of treatment of oral cavity disorders.Specifically, the invention refers to a composition for treatingxerostomia and its associated problems.

BACKGROUND OF THE INVENTION

Saliva is a natural fluid whose function is essential for oropharyngeal,digestive and general health. Salivary function is apparently simple;however, the complexity of its composition reflects its large number ofproperties. When the amount or quality of saliva diminishes, multipleproblems occur called xerostomia or “dry mouth” or “burning mouth”.

The WDF (World Dental Federation) defines it as the “modern man'sdisease” due to its high incidence. The percentages it has establishedrange from 20% in people around 20 years of age, and 40% in people of 60years of age, being higher in older age groups.

Xerostomia or dry mouth is a universal problem that can affect anybody,independently of their sex, race, age or other conditions. However, itis more frequent in women than in men, mainly due to the reduction ofoestrogen hormones in perimenopause, in the same manner as drynessappears in other mucosa such as the vagina and the eyes. One of everyfour adults suffers from dry mouth. Furthermore, it is associated tomultiple systemic and psychiatric diseases, and more importantly, itappears as a secondary effect to multiple treatments of these and otherdiseases that are becoming more frequent, even reaching epidemiccharacteristics. Among these are diabetes, cancer, anxiety, depression,allergies, autoimmune diseases, stress or alcoholism, for example.

It is for all the former that xerostomia or “dry mouth syndrome” is sorelevant today. Furthermore, it is a syndrome that can be silent in manycases and that may not show symptoms until it is very advanced. 50% ofxerostomia patients do not show any symptoms, and what is scientificallymore relevant, up to 50% of salivary flow may be lost without yetperceiving dryness in the mouth or before xerostomia manifests itselfwith signs or symptoms.

Xerostomia or dry mouth syndrome affects both people with dentition(toothed patients) and toothless patients. The consequences of saidxerostomia in the first group are very manifest, since an alteration ofthe natural buffering capacity of saliva also occurs a few months aftersyndrome insaturation, due to the deficit in salivary flow, leading toshort-term structural deterioration of the hard tissues in the mouth(teeth).

In toothed patients with xerostomia, the saliva that under normalphysiological conditions acts as a defence, barrier and reinforcement,is no longer effective or sufficient to slow down the demineralizationof enamel and dentin caused by daily aggressions (cariogenic bacteria,acids, drops in pH, dental bruxism or clenching . . . ) Thus, forexample, rapidly evolving caries and atypical caries such as neck cariesoccur as a result of the postprandial (after eating) decrease in oralpH, which can completely destroy teeth in a few months. Furthermore, awhole series of symptoms and signs can occur, independently of whetherthere are teeth or not, which can even alter the patient's quality oflife.

In toothless patients, xerostomia does not cause dental destructionsince the patient has already lost all his teeth. However, theappearance of signs and symptoms can be even greater than for the firstgroup.

Different types of glands are responsible for said secretions:mucilaginous saliva is secreted by the minor salivary glands (labial,palatine, lingual), whereas aqueous saliva is secreted by the parotidand submaxillary glands in much larger amounts.

Dry mouth symptoms are frequently present in patients whose salivarysecretion, both stimulated and unstimulated, is normal. In contrast,there are patients with true hyposalivation who do not complain ofbuccal dryness. Perception by the patient largely depends on thesalivary component that is lacking: buccal dryness is felt whenmucilaginous components are missing (scientifically called resting orunstimulated saliva) which lubricate and provide comfort, although theamount of salivary flow (flow of aqueous or stimulated saliva) may bethe same. In contrast, patients with a decrease in salivary flow may notperceive dryness if they preserve mucilaginous saliva.

Today it is known that it is resting or unstimulated saliva whichprevents the symptoms and protects both soft tissues (tongue and mucosa)and hard tissues (teeth). A comparison could be made with tears (crying)when upset, which do not perform the function of protecting the eye,since they fall down the face, very different to lachrymal secretionthat lubricates and protects ocular structures from the external medium,protecting normal vision.

Both kinds of saliva, stimulated and unstimulated or resting, arenotably different in volume, glandular origin and composition. Restingsaliva is that which lubricates and provides the feeling of calmness.One of the preferred theories indicates that this may be due to the highconcentration of potassium ions in their buffer system, which,scientifically, is the most used cation in desensitizing toothpastes andgels. In contrast, stimulated saliva has large amounts of sodium.

There is great individual variability regarding salivary flow. It candiffer by up to 50%.

Xerostomia makes talking, chewing and swallowing difficult, and alsooral hygiene since it favours the accumulation of dental plaque becausethe salivary flow no longer washes out bacteria. Furthermore, it reducesthe buffer effect of saliva, making the pH become acid and destroyingthe teeth. It is related to many chronic pharyngitis, mucositis and evento digestive disorders. At a local level it can cause a feeling ofburning and/or pain in the soft tissues and in the tongue, a need formoisturizing the mouth at short time intervals, leaves surfaces of theteeth rough, a sliver of saliva between the teeth or the tongue and thepalate, a feeling of pressure or tightness in a group of teeth and evenpain. It causes a fast progression of tooth decay, it facilitatesperiodontal diseases (gingivitis), and it wears out teeth due to greaterabrasion and friction without lubrication between dental surfaces. Italso causes fissures in the lips and bacterial infections (candidiasis,sialodentitis), halitosis, and it can even produce eating disorders,insomnia, irritability or depression. Likewise, xerostomia affects thesufferers quality of life from the point of view of sociability: thereis a lack of interest for eating in company, for going out or fortalking in groups.

The ethiology of xerostomia involves many factors and is highly complex:

1. Consumption of mouth-drying drugs: More than 500 families of drugshave xerostomia as a side effect, this being one of the main reasons formedication discontinuation by patients. These are responsible for mostcases of xerostomia. Salivary deficiency usually lasts a long time afteran extended treatment, despite drug discontinuation.

The drugs that produce this effect most frequently are diuretics(hydrochlorothiazide, amiloride), sedatives, antidepressants (serotoninreuptake inhibitors and especially tricyclic antidepressants),antihypertensives, antiinflammatory drugs, decongestants(phenylpropanolamine, pseudoephedrine), anxiolytic drugs (diazepam),anticholinergic-type antispasm drugs (atropine, oxybutynin),antidiarrheal (loperamide, diphenoxylate), antihistamines(chlorphenamine, loratadine), non-steroid antiinflammatory drugs(piroxicam, ibuprofen), opioid analgesics (morphine), muscle relaxants(baclofen), bronchodilators (ipratropium, salbutamol), antiparkinsondrugs (levodopa, biperiden), antiacne drugs (isotretinoin) andantipsychotics such as phenothiazines and butyrophenones.

2. Oncological treatments such as head and neck radiotherapy (one of themost widely recognised causes). Also, and more frequently, oncologicalchemotherapy. And also radioactive iodine therapy in thyroid carcinoma.

3. Autoimmune diseases: they permanently reduce salivary flow. We canhighlight Sjögren's Syndrome, systemic lupus erythematosus, rheumatoidarthritis, polymyositis/dermatomyositis and scleroderma.

4. Infectious diseases: HIV, hepatitis.

5. Transplant patients with immunosuppressive therapy: salivary glandhypofunction.

6. Dialysis patients.

7. Systemic diseases such as diabetes, arthritis, Alzheimer and seniledementia.

8. Psychiatric diseases such as anxiety, depression and nervousanorexia.

9. Consumption of addictive substances such as alcohol, tobacco anddrugs. A common factor in our times.

In any case, it is important to diagnose and treat xerostomia because aswell as the loss of quality of life for the patient, it also seriouslyaffects the patient's health.

This shows that xerostomia is a very complex syndrome. Until now therehave only been failed attempts regarding treatment, focused on imitatingnatural saliva with artificial products that try to substitute theabsent natural saliva.

Thus, until now attempts had been made in the sense of creatingartificial salivas, although said products are not exempt of critiques,since in general, due to their rheologic and organoleptic features, theyare usually gels with acid, even very acid, pH levels, with thesubsequent risk this entails for the dry mouth patient. (“DentalManagement and Treatment of Xerostomic Patients”, by Dr. Carl W.Haveman, D.D.S., M.S., Director, Advanced General Dentistry Clinic, TheUniversity of Texas Health Science Center at San Antonio—Texas DentalJournal, June 1998, pp. 43 to 56); “The effect of commercially availablesaliva substitutes on predemineralised bovine dentin in vitro”, byDepartment of Operative Dentistry and Periodontology. University Schoolof Dental Medicine, Freie Unversitaet, Berlin, Germany—Oral Diseases #8,pp. 192-198).

Therefore, there is still a need in the state of the art for providingalternative compositions for treating xerostomia that increase the flowof resting or unstimulated saliva.

The present inventors have discovered that the combination of olive oil,trimethylglycine and xylitol has a synergic effect since it surprisinglyachieves increasing in almost 200% the salivary flow of resting orunstimulated saliva, managing to alleviate the symptoms of dry mouthsyndrome, including pain, and improving the quality of life of patients.

A study by Kelly et al. (“Bioadhesive, rheological, lubricant and otheraspects of an oral gel formulation intended for the treatment ofXerostomia”, H. M. Kelly, P. B. Deasy, M. Busquet, A. A. Torrance.School of Pharmacy, Trinity College, University of Dublin,Ireland—International Journal of Pharmaceutics 2004 #278, pp. 391-406),describes an artificial saliva with sialogogues or stimulants based onpotassium chloride, sodium chloride, calcium chloride and magnesiumchloride, which are also those which increase the flow of stimulatedsaliva and which can also comprise sunflower oil or olive oil in orderto improve the bioadhesion and viscosity thereof, although the authorsindicate the curiosity that the saliva is neither sticky or viscous. Theuse of olive oil has also been described as a greasy vehicle incompositions for treating dermatological disorders related to dry mucosa(patents US 200528174 and AT 414095).

Xylitol has been included as an ingredient in numerous products for drymouth, with a proven benefit as a non-carcinogenic sweetening agent(see, for example, patent ES 2186569). However, it has not been possibleto prove its capacity per se for stimulating salivary flow (Caries Res.1993; 27(1):55-9; Caries Res. 1999; 33(1):23-31). In fact, its functionas a salivary stimulant in chewing gum and confectionery products,described in patent ES 2057412, for example, seems to be due more to thevehicle, since any gum, hard or soft plastic in the mouth is capable ofpromoting stimulated salivary flow even without any active ingredients(J. Dent. Res. 1989; 68(5):786-90).

On the other hand, U.S. Pat. No. 5,156,845 describes the use of betainehydrochloride to stimulate stimulated salivary flow based on the aciditythe molecule contributes to the composition. Likewise, U.S. Pat. No.6,156,293 by Jutila, defines the use of trimethylglycine to alleviatethe symptoms of dry mucosa and membranes of the body in non-therapeuticpreparations, since they do not increase any vital physiologicalfunction. The author describes trimethylglycine as a bipolar compoundthat can adhere to the surface of mucosal membranes and stay there forsome time binding water and thus moistening them.

However, the combined use of olive oil, xylitol and trimethylglycine hasnot been described in the state of the art as a therapeutic compositionfor improving salivary physiological function in treating xerostomia.The composition of the invention does not only achieve alleviating themost important symptoms of this serious problem, but also, thanks to thesurprising increase in unstimulated salivary flow, it achieves all thebenefits provided by natural saliva.

Furthermore, also surprisingly, said synergic combination is capable ofprotecting against dentin demineralization, whereas none of theingredients separately achieves this, thus preventing or reducingproblems related to xerostomia such as caries, for example.

Buchalla et al. (“Influence of Olive Oil Emulsions on DentinDemineralization in vitro”, W. Buchalla, T. Attin, P. Roth, E. Hellwig.Freiburg University, Germany—Caries Research 2003 #37, pp. 100 to 107),have described the protective effect against dentin demineralisation ofoily emulsions with 5% and 50% of olive oil, concluding that the latterprotects more than the first, but without significant differences.Likewise, the studies by Featherstone and Rosenberg (Caries Res 18(1984) 52-55) had shown that lipids provide a diffusion film in theorganic aquo-lipo-proteic matrix of enamel, hindering the occurrence ofcaries.

On the other hand, the results obtained from the erosion protectionstudies enclosed do not reveal any capacities of olive oil forprotecting against demineralisation under the conditions in which thecombination of the three ingredients do so in enamel and dentin.

Furthermore, the combination of the three components of the compositionof the invention has not been suggested or described to have such asurprising effect regarding preventing the loss of dentin, greater thanthat provided by the ingredients independently. This property isespecially important in xerostomia patients, since gum dehydrationproduces an exposure of dentin, which is especially sensitive todemineralisation.

Therefore, the composition of the present invention combining the activeingredients mentioned allows treatment of xerostomia or disordersassociated with it with very good results in increasing the flow ofresting saliva, in alleviating the symptoms and pain associated toxerostomia as well as improving the quality of life of affected persons.Furthermore, the composition of the invention has been proved to protectagainst demineralisation of dentin subjected to extreme pH conditionssimilar to those existing in the mouth without saliva.

OBJECT OF THE INVENTION

The object of the present invention, therefore, is to provide acomposition for treating xerostomia, comprising a synergic combinationof olive oil, trimethylglycine and xylitol.

DESCRIPTION OF THE DRAWINGS

FIG. 1 represents the values of unstimulated salivary flow at thebeginning and after one week of topical application of usual productsfor dry mouth (control) and of the composition of the invention (test).

FIG. 2 represents the change of symptoms according to the results of theXerostomia VAS questionnaire after one week of topical application ofusual products for dry mouth (control) and of the composition of theinvention (test).

FIG. 3 represents the changes detected in quality of life related toxerostomia after the use of usual products for dry mouth (controlproducts) and the composition of the invention (tested products).

FIG. 4 represents dentin loss under conditions of extreme erosion usingdistilled water, olive oil and the composition of the invention (testedsolution).

FIG. 5 represents enamel loss under conditions of extreme erosion usingdistilled water, olive oil and the composition of the invention (testedsolution).

FIG. 6 represents dentin loss under conditions of extreme erosion usingdistilled water, the composition of the invention and solutions of eachone of the three components thereof (2% olive oil, 2% trimethylglycineand 1% xylitol).

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides a composition for treating xerostomiacomprising olive oil, trimethylglycine and xylitol, hereinafter“composition of the invention”.

Within the context of the invention, the term “composition for treatingxerostomia” refers to a composition that improves the physiologicalfunction, that is, increases the flow of unstimulated saliva in aphysiological manner. Hence, it is a therapeutic composition and not amere oral hygiene product. Furthermore, said composition alleviates thesymptoms thereof, including xerostomia-associated pain, and improves thequality of life of the persons affected. The composition has also provedto be effective in preventing the demineralisation caused by acids.

As has been previously indicated, the invention is aimed at preservingand increasing natural salivary flow for “resting saliva” by the use ofa novel and innovative topical therapeutic composition. It has theadvantage that it can be applied “ad libitum”, that is, when needed (thepatient suffers from dry mouth all day long, even at night), without theside effects of stimulating drugs known until now, such as in the caseof pilocarpine.

The composition of the invention, by stimulating salivary flow, managesto increase the amount of calcium, potassium, phosphate and bicarbonateions, as well as of the rest of beneficial components that natural humansaliva contains, such as proteins, immunoglobulins, peroxidase, etc.

In a particular embodiment, the composition of the invention comprises0.1-4% by weight of olive oil. In a preferred embodiment, thecomposition of the invention comprises 0.2-3% by weight of olive oil. Inan even more preferred embodiment, the composition of the inventioncomprises 2% by weight of olive oil.

In a particular embodiment, the composition of the invention comprises0.1-6% by weight of trimethylglycine. In a preferred embodiment, thecomposition of the invention comprises 4% by weight of trimethylglycine.

In a particular embodiment, the composition of the invention comprises1-50% by weight of xylitol. In a preferred embodiment, the compositionof the invention comprises 5-30% by weight of xylitol. In an even morepreferred embodiment, the composition of the invention comprises 10% byweight of xylitol.

In a preferred embodiment, the composition of the invention comprises 2%by weight of olive oil, 4% by weight of trimethylglycine and 10% byweight of xylitol. In another preferred embodiment, the composition ofthe invention comprises 2% by weight of olive oil, 2% by weight oftrimethylglycine and 1% by weight of xylitol.

In another particular embodiment, the composition of the invention canfurther comprise one or more components such as remineralising agents,viscosity-controlling agents, moisturising agents, preservatives,colorants, buffer agents, sweeteners, proteolytic enzymes, emulsifiers,abrasives, essential oils, cicatrizing agents, aromas, antioxidants,animal or plant gelatines, excipients, and a mixture thereof.

Among these supplementary ingredients we can highlight the agents thatimprove remineralising capacity, since they contribute ions that allowremineralisation, specifically fluorine from any appropriate source,calcium from any appropriate source, as well as phosphates or other ionswith remineralising capacity and capable of hardening the teeth.

Therefore, in a preferred embodiment, the composition of the inventioncomprises a remineralising agent chosen among fluoride anions, phosphateanions, sodium cations and potassium cations.

Among the aforementioned we can cite the following as examples:potassium fluoride, sodium fluoride, sodium monofluorophosphate, tinfluoride, amine fluorides (hexadecylamine hydrofluoride,bis(hydroxyethyl)aminopropyl-N-hydroxyethyl-octadecylaminedihydrofluoride,N—N′,N′-tri(polyoxyethylene)-N-hexadecyl-propylenediaminedihydrofluoride or octadecenylamine hydrofluoride), potassium phosphate,potassium pyrophosphate, tripotassium citrate, calcium lactate, calciumpantothenate and calcium carbonate.

Likewise, any rheologic agent known in the state of the art can be usedas viscosity-controlling agents, such as gum arabic, tragacanth gum,xanthan gum, carboxymethyl cellulose (CMC), carbopol-type polymers,pectins or mucines.

Likewise, any moisturising agent of the state of the art can be used inthe composition of the invention, such as, for example, glycerine,propylene glycol or sorbitol.

Among the preservatives that can be used in the composition of theinvention we can mention sodium benzoate, benzoic acid, diazolinyl urea,imidazolinyl urea, sodium methylparaben, sodium propylparaben, amongother preservatives of the state of the art.

On the other hand, any colorant of the state of the art can be used inthe composition of the invention, such as, for example, C.I. 75810 ortitanium dioxide.

Likewise, in the composition of the invention any buffer agents orpH-regulating agents known in the state of the art can be used, amongwhich we can mention the following: lactic acid and lactates, citricacid and citrates, malic acid and salts thereof, sodium hydroxide,potassium phosphate and potassium pyrophosphate.

Among the sweeteners that can be used in the composition of theinvention we can mention maltitol, isomaltitol, manitol, lactitol,sodium saccharine, acesulfame potassium, aspartame, cyclamate, taumatinor neohesperidine DC, among other known sweeteners.

Proteolytic enzymes such as papain, for example, can also beincorporated to the composition of the invention.

Likewise, any suitable emulsifier of the art can be used in thecomposition of the invention, such as, for example, PEG-40 hydrogenatedcastor oil or lecithin.

On the other hand, any abrasive used in this field of the art can beused in the composition of the invention, such as hydrated silicas(Syloid 244, Zeodent 163 or Zeodent 623, for example).

Likewise, the composition of the invention can incorporate essentialoils such as parsley seed oil or citrus medica extract, to name a few.

Another optional component of the composition of the invention is anycicatrizing agent of the art such as allantoin, D-panthenol, calciumpantothenate, for example.

Likewise, the composition of the invention can comprise a suitableantioxidant of the state of the art such as tocopherol acetate orvitamin C.

On the other hand, the composition of the invention can comprise animalor plant gelatines such as bovine gelatine, fish gelatine or algaegelatine, for example.

The composition of the invention can also include aromas such as citrusmedica or mint extracts, for example.

Finally, suitable excipients will be added to the composition of theinvention according to the formulation they are intended for. Thus,beeswax, gum base, carnauba wax or shellac, etc can be used.

In the case of liquid and doughy preparations, water is used as asolvent.

The composition of the invention, which comprises olive oil,trimethylglycine and xylitol, has a neutral pH in order to guaranteeindemnity of the enamel and dentin of dry mouth patients. Furthermore,the invention does not contemplate the use of sodium lauryl sulphate,sodium lauryl sarcosinate, cocamidopropyl betaine (do not mistake withbetaine) and detergents commonly used in oral hygiene products and whichare associated to the occurrence of recurrent sores and ulcerations(Herlofson B). Likewise, it lacks alcohol in order to preventassociation between the latter and oral cancer, and essentially, toprevent its known dehydrating effect.

As has been indicated, according to the desired presentation it caninclude at each time all that necessary for it to have the necessaryorganoleptic and rheologic form.

In a particular embodiment, the composition of the invention isformulated as a toothpaste, mouthwash, salivary substitute, spray, gel,chewing gum, suckable capsules, suckable lozenges, palate sheets,tablets, sweets, impregnated oral swabs, impregnated oral gauzes,suckable single-dose presentations of frozen solution.

In general, as well as the swabs and gauzes, any suitable supportimpregnated with a solution of the invention can be used for topicalapplication in the mouth. Likewise, a single-dose presentation (asuitable sachet or blister, for example) of the solution of theinvention that is frozen before use can be used. Thus, to the effect ofthe novel composition of the invention is added the effect of the coldin order to achieve faster and more effective alleviation from the painassociated to xerostomia.

In any case, the expert in the art will formulate the composition of theinvention in any suitable presentation that allows a simple use thereoffor the xerostomia patient in order to calm pain and stimulate salivaryflow.

The composition of the invention has been proved to triplicate salivaryflow for resting saliva, increasing it by almost 200%. Said combinationhas also been proved to improve the symptoms, the pain and quality oflife associated to dry mouth syndrome.

Furthermore, and surprisingly, said association is capable of protectingagainst dentin demineralisation.

The composition comprises ingredients the novel combination of which hasbeen proved to have very beneficial effects for dry mouth but which,however, do not individually present the effectiveness proved for thecomposition.

The following examples illustrate the invention and should not beconsidered as limiting the scope thereof.

Example 1

Toothpaste formulation Percentage Component (w/w) Olive oil 2.000Trimethylglycine 4.000 Xylitol 10.000 Glycerine 31.400 Water 27.950Zeodent 163 10.000 Zeodent 623 6.000 Tetrapotassium 2.300 pyrophosphateSyloid 244 2.000 D-Panthenol 0.050 Tocopherol acetate 0.050 Titaniumdioxide 1.000 Papain 0.100 Potassium phosphate 0.900 Citrus medica 0.500Xanthan gum 1.000 Sodium fluoride 0.220 Sodium saccharine 0.130Diazolinyl urea 0.100 Parsley oil 0.300 TOTAL 100

Example 2

Mouthwash formulation Percentage Component (w/w) Olive oil 0.200Trimethylglycine 2.000 Xylitol 1.000 Water 90.095 PEG-40 hydrogenated2.000 castor oil Glycerine 2.000 Propylene glycol 1.000 Citrus medica0.400 Diazolinyl urea 0.300 Lactic acid 0.200 Allantoin 0.200 Sodiummethylparaben 0.200 Sodium propylparaben 0.150 Potassium fluoride 0.070C.I. 75810 0.050 D-Panthenol 0.050 Tocopherol acetate 0.050 Aroma 0.005Parsley oil 0.030 TOTAL 100

Example 3

Mouthwash formulation Percentage Component (w/w) Olive oil 2.000Trimethylglycine 2.000 Xylitol 1.000 Water 81.859 PEG-40 hydrogenated10.300 castor oil Citrus medica 0.400 Sodium methylparaben 0.200 Sodiumpropylparaben 0.100 Sodium benzoate 0.130 Benzoic acid 0.200 Allantoin0.200 Potassium fluoride 0.070 C.I. 75810 0.050 D-Panthenol 0.500Tocopherol acetate 0.500 Aroma 0.205 Parsley oil 0.286 TOTAL 100

Example 4

Salivary substitute formulation Percentage Component (w/w) Olive oil1.000 Trimethylglycine 4.000 Xylitol 10.000 Glycerine 42.602 Water30.000 Tripotassium citrate 6.050 Carbopol 980 1.500 Potassiumpyrophosphate 1.150 Xanthan gum 1.000 Calcium lactate 1.000 Citrusmedica 0.500 Potassium phosphate 0.450 Sodium benzoate 0.400 Sodiumsaccharine 0.100 Tocopherol acetate 0.050 D-Panthenol 0.050 Parsley oil0.148 TOTAL 100

Example 5

Spray formulation Percentage Component (w/w) Olive oil 1.000Trimethylglycine 2.000 Xylitol 10.000 Water 75.002 PEG-40 hydrogenated5.750 castor oil Glycerine 2.000 Propylene glycol 1.000 D-Panthenol0.500 Tocopherol acetate 0.500 Calcium lactate 0.500 Diazolinyl urea0.450 Citrus medica 0.400 Allantoin 0.200 Sodium methylparaben 0.200Lactic acid 0.200 Sodium propylparaben 0.150 Parsley oil 0.143 Aroma0.005 TOTAL 100

Example 6 Efficacy of the Composition of the Invention in a Populationof Adults Suffering Symptoms of Hyposalivation and Xerostomia Materialsand Methods Subjects

A total of 40 participants were recruited and enrolled from a generalpopulation aged 50-67 years.

All the subjects reported a history of dry mouth symptoms due topolypharmacy. All the subjects complied with the following requirements:

No. 1 Subjects suffering from dry mouth symptoms valued above 30 mm onat least one of the eight questions of the dry mouth VAS questionnaire.No. 2 Subjects with an unstimulated salivary flow equal to or below 0.2ml/minute. No. 3 Subjects between 50 and 90 years of age. No. 4 Subjectstaking at least three drugs associated with the hypo- function ofsalivary glands or xerostomia (anxiolytics, anorexiants,anti-asthmatics, anti-cholinergics, anti-depressants, anti-emetics,anti-histamines, anti-hypertensives, anti-parkinsonians, anti-psychotics, decongestants, diuretics or sedatives, for example) No. 5Subjects taking drugs according to the previous point for at least oneweek before the start of the study. No. 6 Subjects willing to use onlythe products indicated by the coordinator during each phase of thestudy. No. 7 Subjects willing to assist to all visits required for thestudy.

The subjects were randomly separated into two groups. Each group, madeup of 20 individuals, used both products (control product and testedproduct) in order to ensure that the results are not subject to theidiosyncrasy of the patients (crossover study).

Unstimulated whole saliva was collected according to a previouslydescribed protocol (Navazesh M. “Methods for collecting saliva”, Annalsof the New York Academy of Sciences, 1993; 694:72-7) at the same time asa standardized oral tissue examination was performed. The coordinatorresponsible for the study facilitated a xerostomia VAS questionnairewith eight assessments of 100 mm each together with a questionnaireaimed at evaluating quality of life associated with xerostomia.

Products of the Study

Topical dry mouth products were used containing the three activeingredients (olive oil, trimethylglycine and xylitol) formulated atneutral pH.

Specifically, the tested products were formulated in four differentpresentations: Toothpaste, mouthwash, spray and gel.

The standard regime for the products tested consisted in: (1) Using thetoothpaste/mouthwash three times a day after main meals, and (2) usingthe spray and gel between meals a minimum of eight times a day.

As a reference or control the subjects were asked to follow their usualtreatment regime for dry mouth.

Study Design

All patients were subjected to a series of baseline measurementsconsisting in the measurement of unstimulated salivary flow according toa previously described protocol (Navazesh, supra) at the same time as astandardized oral tissue examination was performed.

The coordinator responsible for the study facilitated a xerostomia VASquestionnaire with eight assessments of 100 mm each together with aquestionnaire aimed at evaluating quality of life related to xerostomia.

The subjects were randomly separated and assigned to protocol 1 orprotocol 2.

Protocol 1. The patients carried on with their usual regime for drymouth treatment, excluding the use of any pharmacological salivarystimulant. On the eighth day, all subjects returned to the researchcentre, where the baseline measurements were repeated and possibleadverse effects were recorded.

Then a crossing was performed so that patients then used the products tobe tested. Fifteen days after the beginning of the study, all subjectsreturned to the research centre. The baseline tests were repeated andpossible side effects were recorded. The subjects of this group thenfinished the study.

Protocol 2. The patients used the products tested according to thestandard usage regime. On the eighth day, all subjects returned to theresearch centre, where the baseline measurements were repeated andpossible side effects were recorded.

Then a crossing was performed so that the patients went on to a washoutperiod during which they could not use any kind of products for drymouth treatment.

Fifteen days after the beginning of the study, the subjects returned tothe research centre. The baseline tests were repeated and possibleadverse effects were recorded. They then went on to use their usual drymouth treatment regime once again. 22 days after the beginning of thestudy, this group returned to the research centre. The baseline testswere repeated and possible side effects were recorded. After this, thestudy was finished.

Unstimulated Salivary Flow Measurements

Unstimulated whole saliva was collected according to a previouslydescribed protocol (Navazesh, supra) at the same time as a standardizedoral tissue examination was performed.

Xerostomia VAS Questionnaire

A validated xerostomia VAS (Visual Analogue Scale) questionnaire wasused, which focuses on eight aspects of dry mouth (Pai S, et al.“Development of a Visual Analogue Scale questionnaire for subjectiveassessment of salivary dysfunction”, Oral Surgery, Oral Medicine, OralPathology, Oral Radiology, & Endodontics, 2001, 91(3):311-6). Thesubjects were asked to make a mark on a 100 mm horizontal line toindicate the level of dryness they suffered. Two of the aspects covered(No. 2 and 3) in the questionnaire are related with salivary glandhypofunction (Fox et al. “Subjective reports of xerostomia and objectivemeasures of salivary gland performance”, Journal of the American DentalAssociation, 1987; 115(4):581-4). Three of the aspects (No. 6, 7 and 8)have been previously used in dry mouth research (Fox et al., supra;Närhi T O. “Prevalence of subjective feelings of dry mouth in theelderly”, Journal of Dental Research, 1994; 73(1):20-5), and dryness oflips (No. 6) successfully predicted salivary gland hypofunction(Navazesh M, et al., “Clinical criteria for the diagnosis of salivarygland hypofunction”, Journal of Dental Research, 1992; 71(7):1363-9).The aspects mentioned are:

No. 1 Evaluates the difficulty experienced when speaking due to drynessNo. 2 Evaluates the difficulty experienced when swallowing due todryness No. 3 Evaluates how much saliva you have in your mouth No. 4Evaluates dryness of your mouth No. 5 Evaluates dryness of your throatNo. 6 Evaluates dryness of your lips No. 7 Evaluates dryness of yourtongue No. 8 Evaluates your thirst level

Questionnaire on Quality of Life Related to Xerostomia

The questionnaire on quality of life related to xerostomia used in thestudy includes 12 questions extracted from a validated form (Henson B Set al., “Preserved salivary output and xerostomia-related quality oflife in head and neck cancer patients receiving parotid-sparingradiotherapy”, Oral Oncology, 2001, 37(1):84-93). This questionnaire isaimed at analysing how dry mouth affects a person's quality of life. Thequestions are classified in three groups: physical function, personalfunction and pain. The questions covered were:

PHYSICAL FUNCTION No. 1 The dryness of my mouth/throat limits the typeof food or the amount of food in my diet No. 2 The dryness of mymouth/throat makes me feel uncomfortable when I speak in front ofsomebody No. 3 The dryness of my mouth/throat interferes with my dailyactivity No. 4 The dryness of my mouth/throat makes the food I eat nottaste good PAIN No. 5 The dryness of my mouth/throat is uncomfortableNo. 6 The dryness of my mouth/throat keeps me worried and conscious ofthe problem No. 7 The dryness of my mouth/throat makes me feel nervousNo. 8 The dryness of my mouth/throat prevents me from enjoying lifePERSONAL FUNCTION No. 9 The dryness of my mouth/throat makes me worryabout the appearance of my mouth and teeth No. 10 The dryness of mymouth/throat reduces my happiness No. 11 The dryness of my mouth/throataffects all the aspects of my life No. 12 If you had to spend the restof your life with the dryness of the mouth/throat that you experiencenow, how would you feel?

The possible answers to the first 11 questions were: (1) not at all, (2)very little, (3) a little, (4) quite a bit and (5) a lot. For question12, the possible answers were: (1) delighted, (2) satisfied, (3) neithersatisfied nor unsatisfied, (4) clearly unsatisfied, and (5) terrible.

Results

Forty (40) subjects were selected to form part of the study, 39 of whichcompleted all the visits.

The analysis of variance indicated that there were no significantdifferences between the initial unstimulated salivary flow between thepatients forming part of protocol 1 (0.046 ml/min) and the patientsforming part of protocol 2 (0.047 ml/min). This ensures that thedifferences found at the end of the study are due to the differenttreatments and not to initial differences between the groups.

Unstimulated Salivary Flow Measurements

FIG. 1 represents the values of unstimulated salivary flow at thebeginning and after one week of topical application of usual productsfor dry mouth (control) and of the composition of the invention (test).The difference between the groups, approximately 180%, is statisticallysignificant at p=0.033.

The results show that the use of the products tested comprising oliveoil, trimethylglycine and xylitol for one week resulted in an increasein unstimulated salivary flow with respect to the group that used itsnormal treatment routine for dry mouth (p=0.033). The average salivaryflow in the group that used the tested product (olive oil,trimethylglycine and xylitol) passed from 0.05 ml/min±0.05 ml/min(mean±standard deviation) to 0.140 ml/min±0.26 ml/min (mean±standarddeviation), whereas the salivary flows in the subjects that followedtheir daily routine kept constant after a period of 7 days (0.047ml/min±0.05 versus 0.05 ml/min±ml/min, mean±standard deviation).

Xerostomia VAS Questionnaire

FIG. 2 shows the change of symptoms according to the results of thexerostomia VAS questionnaire after one week of topical application ofusual products for dry mouth (control) and of the composition of theinvention (test). Positive changes imply a reduction of symptoms,negative changes imply an increase of symptoms, and neutral changesimply that there are no changes. The difference between the groups forthe group of the eight questions is statistically significant (p=0.011).

The results of the xerostomia VAS questionnaire demonstrated that theuse of the tested products also produced an improvement of symptomsgenerally greater than that produced by the products of their usualregimes for treating dry mouth (control) (p=0.011) for the same timeperiod.

Questionnaire on Quality of Life Related to Xerostomia

FIG. 3 represents the changes detected in quality of life related toxerostomia after the use of usual products for dry mouth (controlproducts) and the composition of the invention (tested products). Thequality of life of the subjects is greater the smaller the value is.Significant differences were found between the groups: physical function(p=0.03), personal function (p=0.03) and pain (p=0.01).

A significant improvement was detected after the use of the testedproducts compared with the usual dry mouth treatment routine (controlproducts): physical function (p=0.03), pain (p=0.03) and personalfunction (p=0.01).

Example 7 Protective Capacity of the Composition of the InventionAgainst Tooth Demineralisation Compared to that of Olive Oil

The protective capacity of a mouthwash formulated with olive oil,trimethylglycine and xylitol on enamel and dentin subjected to extremeerosion conditions compared with that of olive oil was analysed. For theevaluation of the effects, a control was included consisting ofdistilled water.

Materials and Methods

Sample Preparation

Incisive teeth extracted from a cow's jaw were used which were immersedin a 0.5% thymol solution at room temperature. The teeth were sectionedat the cementum-enamel junction by means of a water-cooled diamondscalpel (Exakt, Norderstedt, Germany), and the crowns and roots wereembedded in acrylic resin cylinders (Paladur, Heraeus Kulzer, Wehrheim,Germany). Radicular cementum was completely eliminated. Enamel anddentin surfaces were then polished so that the thickness of theoutermost layer of enamel and dentin was reduced to approximately 200μm, controlling this by means of a micrometer (Digimatic®, Micrometer,Mitutoyo, Tokyo, Japan).

Each enamel and dentin sample was covered with adhesive tape (Tesa,Beiersdorf, Hamburg, Germany) on both sides, leaving an exposed windowof 3 mm width. The adhesive tape thus protected the original surfacesthat served as a reference in the profilometric measurement. The sampleswere stored in water until the time of the experiment.

Study Design

The specimens of enamel and dentin were subjected to 10 cycles ofpre-treatment, remineralisation, demineralisation and remineralisation.Pre-treatment consisted in immersing each specimen for 5 minutes in oneof the following preparations: (A) distilled water; (B) mouthwash witholive oil, trimethylglycine and xylitol; and (C) olive oil.

After the pre-treatment, the samples were rinsed with water andtransferred to artificial saliva (Klimek et al, 1982) for 30 minutes.Demineralisation was subsequently carried out by immersing the specimensin a 1% citric acid solution (pH: 2.3) for 3 minutes. Afterdemineralisation, the samples were rinsed with water and once againtransferred to the artificial saliva, this time for 60 minutes. Thiscomplete cycle (5 minutes of pre-treatment, 30 minutes in artificialsaliva, 3 minutes in erosive conditions and 60 minutes in artificialsaliva) was repeated 10 times.

Profilometric Measurements

Loss of enamel and dentin was quantified performing profile orprofilometric measurements (Mahr Perthometer, Göttingen, Germany). Priorto the experiment, baseline measurements were taken that would serve toevaluate the surfaces that would be used as reference to calculate thelosses in enamel and dentin after the experiments. To this end, sixmarks were performed in the centre of each specimen at 1000 μmintervals. The length of the profile measurements is performed along 250μm with data collection every 0.69 μm. After the experiment the adhesivetapes were removed and the samples were analysed again. The averagedepth of the eroded surfaces was thus calculated with respect to basicsurface profiles by means of specific software (Mahr Perthometer Concept7.0, Mahr, Göttingen, Germany).

Statistical Analysis

The loss of enamel and dentin was calculated (mean±standard deviation)for each group and statistically analysed by Student's t test followedby Bonferroni's t test for multiple comparisons (Statistica 6.0,Statsoft, Tulsa, USA).

Results

The mean value for dentin loss in the three groups is shown in FIG. 4.

Dentin loss in the control group (A) was 9.6 μm±1.0. The resultsobtained with olive oil (B) do not show differences with respect todistilled water (9.21 μm±1.5). The tested solution (C) shows animprovement with respect to water and olive oil (7.41 μm±0.9) althoughsaid improvement is significant only for water.

The mean value for enamel loss in the three groups is shown in FIG. 5.

Dentin loss in the control group (A) was 26.7 μm±1.3. The resultsobtained with olive oil (B) do not show differences with respect todistilled water (28.7 μm±1.8). The tested solution (C) shows asignificant improvement with respect to water and olive oil (21.2μm±1.1).

Therefore, although 100% olive oil does not exert any protection againstthe demineralising conditions of an acid solution at a pH of 2.3, thecomposition of the invention, however, has a marked protective effect onenamel and dentin against demineralising conditions.

Example 8 Protective Capacity of the Composition of the InventionAgainst Tooth Demineralisation Compared to that of the Three IngredientsThereof Separately

The protective capacity of a mouthwash formulated with olive oil,trimethylglycine and xylitol in dentin subjected to extreme erosionconditions was analysed, compared to that of aqueous solutions of thethree ingredients separately in the same concentrations used in themouthwash tested. For the evaluation of effects a control was includedconsisting of distilled water.

Materials and Methods

Sample Preparation

Incisive teeth extracted from a cow's jaw were used, which were immersedin a 0.5% thymol solution at room temperature. The teeth were sectionedat the cementum-enamel junction by means of a water-cooled diamondscalpel (Exakt, Norderstedt, Germany), and the crowns and roots wereembedded in acrylic resin cylinders (Paladur, Heraeus Kulzer, Wehrheim,Germany). Radicular cementum was completely eliminated. Dentin surfaceswere then polished so that the thickness of the outermost layer ofdentin was reduced to approximately 200 μm, controlling this with amicrometer (Digimatic®, Micrometer, Mitutoyo, Tokyo, Japan).

Each dentin sample was covered with adhesive tape (Tesa, Beiersdorf,Hamburg, Germany) on both sides, leaving an exposed window of 3 mmwidth. The adhesive tape thus protected the original surfaces that wouldserve as a reference in the profilometric measurement. The samples werestored in water until the time of the experiment.

Study Design

The dentin specimens were subjected to 10 cycles of pre-treatment,remineralisation, demineralisation and remineralisation. Pre-treatmentconsisted in immersing each specimen for 5 minutes in one of thefollowing preparations: (A) distilled water; (B) mouthwash with oliveoil, trimethylglycine and xylitol; (C) 2% emulsion of olive oil inwater; (D) 2% aqueous solution of trimethylglycine and (E) 1% aqueoussolution of xylitol. Solutions C, D and E are prepared with the samepercentages in which the ingredients form part of tested mouthwash B.The 2% emulsion of olive oil in water was prepared by means of ahigh-speed mixer prior to each treatment, resulting in a finelydispersed emulsion.

After the pre-treatment, the samples were rinsed with water andtransferred to artificial saliva (Klimek et al, 1982) for 30 minutes.Demineralisation was subsequently carried out by immersing the specimensin a 1% citric acid solution (pH: 2.3) for 3 minutes. Afterdemineralisation, the samples were rinsed with water and once againtransferred to the artificial saliva, this time for 60 minutes. Thiscomplete cycle (5 minutes of pre-treatment, 30 minutes in artificialsaliva, 3 minutes in erosive conditions and 60 minutes in artificialsaliva) was repeated 10 times.

Profilometric Measurements

Dentin loss was quantified performing profile or profilometricmeasurements (Mahr Perthometer, Göttingen, Germany). Prior to theexperiment, baseline measurements were taken that would serve toevaluate the surfaces that would be used as reference to calculate thelosses in dentin after the experiments. To this end, six marks wereperformed in the centre of each specimen at 1000 μm intervals. Thelength of the profile measurements is performed along 250 μm with datacollection every 0.69 μm. After the experiment the adhesive tapes wereremoved and the samples were analysed again. The average depth of theeroded surfaces was thus calculated with respect to basic surfaceprofiles by means of specific software (Mahr Perthometer Concept 7.0,Mahr, Göttingen, Germany).

Statistical Analysis

Dentin loss was calculated (mean±standard deviation) for each group andstatistically analysed by Student's t test followed by Bonferroni's ttest for multiple comparisons (Statistica 6.0, Statsoft, Tulsa, USA).

Results

Mean dentin loss in groups A-E is shown in FIG. 6.

Dentin loss in the control group (A) was of 9.6 μm±1.0. The testedsolution (B) was the only one that demonstrated a protective effectagainst erosion (7.4 μm±0.9), whereas application of the 2% olive oilemulsion (C), the 2% trimethylglycine solution (D) and the 1% xylitolsolution (E) did not demonstrate any protective effect on dentin.

1. A composition for treating xerostomia, said composition comprisingolive oil, trimethylglycine and xylitol.
 2. A composition according toclaim 1, comprising 0.1-4% by weight of olive oil.
 3. A compositionaccording to claim 2, comprising 0.2-3% by weight of olive oil.
 4. Acomposition according to claim 3, comprising 2% by weight of olive oil.5. A composition according to claim 1, comprising 0.1-6% by weight oftrimethylglycine.
 6. A composition according to claim 5, comprising 4%by weight of trimethylglycine.
 7. A composition according to claim 1,comprising 1-50% by weight of xylitol.
 8. A composition according toclaim 7, comprising 5-30% by weight of xylitol.
 9. A compositionaccording to claim 8, comprising 10% by weight of xylitol.
 10. Acomposition according to claim 1, said composition comprising 2% byweight of olive oil, 4% by weight of trimethylglycine and 10% by weightof xylitol.
 11. A composition according to claim 1, said compositioncomprising 2% by weight of olive oil, 2% by weight of trimethylglycineand 1% by weight of xylitol.
 12. A composition according to claim 1,said composition comprising one or more components selected from thegroup consisting of remineralising agents, viscosity-controlling agents,moisturising agents, preservatives, colorants, buffer agents,sweeteners, proteolytic enzymes, emulsifiers, abrasives, essential oils,cicatrizing agents, aromas, antioxidants, plant and animal gelatines,excipients, and mixtures thereof.
 13. A composition according to claim1, wherein the composition is formulated as one selected from the groupconsisting of as a toothpaste, mouthwash, salivary substitute, spray,gel, chewing gum, suckable capsules, suckable lozenges, palate sheets,tablets, sweets, impregnated oral swabs, impregnated oral gauzes, andsuckable single-dose presentations of frozen solution.